Orthopedic Traumatology: An Evidence-Based Approach


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Physicians are under increasing pressure to provide quality health care in the most cost-effective way possible. The escalating costs of orthopedic care are driving the need to base clinical decision making on evidence-based data that will help physicians provide optimal care to every patient. Evidence-based medicine is the future of orthopedic surgery. In a world where the quality of surgical outcomes will be increasingly measured, evidence-based data will heavily guide decision making in orthopedic trauma. Orthopedic Traumatology: An Evidence-Based Approach provides the reader with a focused and comprehensive review of the literature surrounding the management of the orthopedic trauma patient. The book centers around clinical scenarios with each chapter based on a specific case. Renowned orthopedic trauma surgeons from across the country serve as contributing authors, writing based on these scenarios and giving their expert opinions on management while using data as their guide. Each chapter describes and summarizes the data, but achieves this objective in a case-based format. Each case is brief, but includes relevant imaging. The case scenarios are heavily weighted toward treatment of more controversial injuries. As there is currently no book on the market that focuses solely on orthopedic trauma and evidence-based medicine, this book is sure to be a useful reference for residents and practicing physicians alike.Orthopedic Traumatology: An Evidence-Based Approach Review
This is an excellent new book which explores an evidence-based approach to orthopedic trauma. The first chapter is an excellent introduction to evidence-based medicine (EBM) written by Drs. C. Foote and M. Bhandari from McMaster University. As most physicians are aware, the origins of EBM can be traced back to McMaster and Drs. Foote and Bhandari do a superb job in describing EBM and discussing aspects of it unique to surgical disciplines. For example, randomized clinical trials may be biased if the surgeon has more expertlse in one of the two procedures being compared. Other caveats of EBM as it applies to orthopedics are succinctly addressed. Despite the complexity of applying the principles of EBM to orthopedics, the textbook is evidence that the discipline has embraced EBM.The book is well-organized. Each chapter follows the same format with a short case presentation, including pertinent Xrays, followed by specific sections, including an interpretation of the clinical presentation, a concisely stated specific diagnosis, a brainstorming paragraph on treatment goals and options, an evaluation of the evidence based literature, a detailed review of pertinent articles, a short paragraph on literature inconsistencies, an evidentiary table which includes the published articles supporting the selected treatment method, followed by a clearly stated definitive treatment plan for the patient presented. Each chapter concludes with a short paragraph predicting long-term outcomes .
The consistency of each chapter is testament to the editors' concept of the book as one that would be clinically useful to any physician interested in learning how orthopedic trauma surgeons think .The text should be of particular interest to medical students and residents who need to quickly acquire a working knowledge of clinical aspects of ortho trauma. The book is organized into classic trauma sections, including the spine; upper extremity; acetabulum, hip and pelvis; lower extremity; and foot and ankle. The final section is particularly interesting and deals with polytrauma, infections and perioperative management. I particularly enjoyed the section on damage control orthopedics, which discusses the complexity of dealing with orthopedic trauma in the setting of multiple injuries with hemodyanamic instability, hypovolemic shock and coagulopathy.
Each chapter is well-referenced. The evidentiary tables concisely summarize the EBM literature reviewed and reinforce the more detailed literature discussion included in the text. One small suggestion for the book's second edition- only 4 of the evidentiary tables include the numbered reference for each study included in the table (chapters 10, 13, 20 and 22). For readers like myself who like to check the literature citations, adding the reference number, in addition to the first author and year published, would be appreciated. Also, a paperback edition would be awesome!
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